AUTHOR=Chen Xiaoyan , Fang Jianxiu , Yang Qingmei , Liu Liping 

TITLE=Predictors of recurrent ischemic stroke: anatomical characteristics of patent foramen ovale

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1658804

DOI=10.3389/fcvm.2025.1658804

ISSN=2297-055X

ABSTRACT=BackgroundPercutaneous closure of patent foramen ovale (PFO) is effective in preventing PFO-related stroke recurrence. Considerable further research aimed at acquiring relevant data is needed to enable reliable identification of the subgroup of patients with PFO who would benefit from such closure.ObjectivesThis study aimed to select optimal candidates for PFO closure; we used echocardiography to assess various anatomical features of PFO, and then determined the value of those features for predicting recurrent PFO-related stroke.MethodsWe used echocardiography to analyze selected anatomical characteristics of PFO, including atrial septal aneurysms (ASA), right-to-left shunts, PFO width, and tunnel length, in patients with PFO-related stroke. The participants underwent PFO closure, mostly plus medication, or medication-only and were followed up for at least 2 years. We compared the rates of recurrent stroke within 2 years between the two groups, and the anatomical characteristics of PFO between patients with and without recurrent stroke using mixed effects Cox models.ResultsThe study comprised 207 patients (120 males, 54.17%). Percutaneous PFO closure was successfully performed in 120 patients (PFO closure group), while 87 received medication-only therapy (medication-only group). After 2 years of follow-up, the risk of recurrent PFO-related ischemic stroke was was significantly lower in the PFO closure group (0.83%) than in the medication-only group (9.2%). The combination of anatomical features of ASA and large right-to-left shunts was associated with recurrent PFO-related stroke. Presence of an ASA alone was independently associated with recurrent PFO-related stroke (B = 2.43, hazard ratio = 11.37; 95% CI: 1.53–85.14; P = 0.012).ConclusionsThe anatomical features of ASA and large right-to-left shunts are associated with recurrent PFO-related stroke in patients with PFO. These patients may derive the most benefit from PFO closure because of the associated greater reduction in absolute risk.